Advocacy & Practice Updates — Advocacy & Practice

Medicare Asking Providers to Revalidate Enrollment Information

Medicare providers must revalidate their enrollment information with the Centers for Medicare & Medicaid Services (CMS) every 5 years. Accordingly, CMS is requiring all providers and suppliers who enrolled before March 25, 2011 to revalidate their Medicare enrollment information by March 23, 2015.

Watch for a notification to reconfirm your status as a Medicare-approved provider.

If you think you might have missed a notification, CMS maintains a complete list of its sent revalidation requests, as well as guides and sample revalidation letters on its Revalidation page. You can also login to the Provider Enrollment Chain & Ownership System (PECOS) web portal to check the status of your enrollment validation.

MACs are notifying providers on a rolling basis

Every 60 days, CMS is sending each Medicare Administrative Contractor (MAC) a list of providers who need to revalidate; your MAC is required to notify you within 60 days of receiving a list from CMS. If you are a provider who must revalidate, you will receive 2 revalidation letters; typically coming in a yellow envelope and mailed to you at the special payment address and correspondence address you have on file with Medicare.

Although MACs are required to send the notifications to specified locations, we recommend that you monitor all of your office locations, billing addresses, and even your home address for a notification.

If you receive a revalidation request from your MAC, it is critical that you respond within 60 days of the postmark date to avoid CMS holding your claims and deactivating your billing capabilities.

PECOS: The fastest and easiest way to revalidate

CMS provides a safe, secure method for revalidating your enrollment information online in place of the paper CMS-855 form: the Medicare Provider Enrollment, Chain, and Ownership System (PECOS).

If you are new to PECOS or need a refresher, CMS offers guides and examples in the downloads section of its PECOS overview website.

From the PECOS web portal:

  1. Login with your user ID and password.
  2. Select My Enrollment.
  3. Find the account that you need to verify and select View Enrollment.
  4. Under Existing Enrollments, you will find fields indicating your Revalidation Status, Revalidation Mailed Date, and Revalidation Received and/or Revalidation Complete Date.
  5. Follow the prompts to complete your revalidation and submit with applicable fees.

Streamlining the revalidation process

To expedite your revalidation application:

  • Respond within 30 days to any requests for additional information when the application is being processed.
  • Specify all national provider identifiers (NPIs) and provider transaction account numbers (PTANs) identified in the revalidation request letter.
  • Provide the employer identification number/taxpayer identification number (EIN/TIN) where applicable.
  • Include written confirmation from the Internal Revenue Service (IRS) confirming your legal business name and EIN (eg, IRS CP-575). Ensure that the legal business name on the IRS document matches the NPI exactly, including any initials, credentials, or suffixes (eg, PC, PA, LLC).
  • Ensure that authorized officials revalidate Medicare enrollment records for a group by signing and dating the certification statement (CMS-855B, Section 15).
  • If you are reassigning all Medicare benefits to a group practice or organization, submit a CMS-855I if being asked to revalidate your individual enrollment records. (Do not submit CMS-855R for revalidation.)
  • Revalidate your own Medicare enrollment records by signing and dating the certification statement (CMS-855I, Section 15).

Published January 2015